Basic Information
| Provider Information | |||||||||
| NPI: | 1356877872 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 286 EUCLID AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921143679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192662111 | ||||||||
| FaxNumber: | 6192660496 | ||||||||
| Practice Location | |||||||||
| Address1: | 286 EUCLID AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921143679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192662111 | ||||||||
| FaxNumber: | 6192660496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2017 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 75591 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 120383 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.